Twelve hours after total thyroidectomy for a multinodular goitre, a woman develops circumoral tingling followed by carpopedal spasm. Serum calcium is 6.8 mg/dL, phosphate 5.9 mg/dL, intact PTH 3 pg/mL. What is the immediate treatment?

• A Oral calcium carbonate 1250 mg three times daily and await outpatient follow-up
• B IM vitamin D 600000 units stat and oral phosphate binder
• C IV furosemide to accelerate calcium clearance
• D IV 10% calcium gluconate infusion with cardiac monitoring ✓

Explanation

Symptomatic postoperative hypocalcaemia with tetany demands IV calcium gluconate under ECG monitoring because QT prolongation predisposes to arrhythmia. Oral calcium plus calcitriol is appropriate later for maintenance once acute symptoms are controlled. Furosemide would worsen hypocalcaemia, and phosphate binders are irrelevant since phosphate is high due to absent renal PTH effect.

Reference: Schwartz's Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.